(P140) FACTORS INFLUENCING PATIENT DECISION AID USE FOR IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR DECISIONS IN THREE CANADIAN ACADEMIC HOSPITALS

Background/Purpose: Patient decision aids (PDAs) are evidence-based tools used to facilitate shared decision-making. Patients exposed to PDAs for implantable cardioverter-defibrillator (ICD) implantation and replacement decisions experience less decisional conflict, improved knowledge, and better values-choice concordance compared to patients receiving standard care. Despite this evidence, PDAs are not routinely used throughout the ICD pathway in Canada. To integrate them into clinical practice, a deliberate approach is required. We sought to identify the factors influencing the implementation of a suite of PDAs for ICD implantation, replacement, and deactivation in the Canadian context.

METHODS/RESULTS: A cross-provincial comparative case study within three academic hospitals in Canada. We conducted interviews/focus groups with health system-level administrators, and from each site, patients with ICDs, family members, nurses, physicians, technicians, and senior-level administrators. We undertook a theory-guided approach to data collection and deductive data analysis using domains and constructs from the Consolidated Framework for Implementation Research (CFIR). Participants (n=74; range 14-33 per site including 2 health systems-level perspectives) identified 28 factors that could hinder or promote the use of PDAs. Some were the same across hospitals, while others differed. According to CFIR domain Intervention Characteristics, the PDAs need to: be available in various formats and languages, reflect current evidence, serve as adjuncts to counseling with opportunity for follow-up, and be recognized as valuable to both patients and healthcare providers. Within the Inner Setting (institution-level), participants reported that institutional support, time, and adequate human resources could enable implementation. In the Outer Setting (provincial-level), the standardization of PDAs used across sites and distinct billing codes could promote use while the potential impact on ICD procedural volumes was cited as a potential deterrent. In terms of Process, timing of PDA distribution, knowledge and comfort with ICD treatment discussions, and the ongoing monitoring of patient outcomes were identified. Despite noted challenges of time, resources, and healthcare providers’ variable comfort level in counseling patients making ICD decisions, participants affirmed that a suite of PDAs could help promote patient-centered care, particularly for patients experiencing decisional conflict. Participants were optimistic that the suite of PDAs could succeed in their setting if supported by key people in the organization and deliberately integrated into existing workflows.

CONCLUSION/IMPLICATIONS FOR PRACTICE: Our theory-guided approach enabled better understanding of the complexity of factors that could influence the uptake of PDAs. These findings were used in a subsequent study phase to prioritize site-specific barriers for selecting appropriate implementation strategies to overcome them.